Amber A. Guth, MD, is a breast surgeon and an associate professor of surgery at New York University Langone Medical Center.
Q: If my cancer is noninvasive, can I skip chemo?
A: Yes, you can skip it. In fact, chemotherapy is never used when breast cancer is noninvasive (also known as in situ because the cancer is trapped within the milk ducts and cant spread outside your breasts). Hormones may be recommended for treatment, but it all depends on the specifics of your case.
Q: If my cancer is invasive, is it still curable?
A: Seventy-five percent of cancers diagnosed in the United States are considered early stageeither stage 0, I, or II, and these stages are generally viewed as curable. While phase III doesn't have as high a cure rate, there are many promising treatments available today for more advanced breast cancer.
Q: What can you tell about my cancer based on its “stage”?
A: We certainly get a lot of information from knowing the stage of your breast cancer, which refers to its size and whether lymph nodes or other parts of your body are involved. But breast cancer treatment is highly individualized; we also look at other factors such as whether the cancer is hormone receptor positive or negative, the microscopic appearance, and most recently, even the genetics of a specific cancer.
Q: If my cancer is hormone receptive, what does that mean for my treatment options?
A: Hormone-receptive cancers can be treated with anti-estrogen therapies. These oral medications are usually well tolerated and do not cause the nausea, hair-loss, or fatigue seen with chemo drugs. (Breast cancer that is hormone-receptor negative tends to be more aggressive, but there are other effective options for that.)
Q: What does the size of my tumor mean for my treatment options?
A: Doctors consider both the absolute size of a cancer and the size relative to the breast. It might be possible to do a lumpectomy on a large cancer in a large breast, for example, but not on a very small breast. Sometimes, if the cancer is large, doctors may suggest chemo or hormones to shrink the tumor before removing it surgically.
Q: What does it mean if the cancer has spread to my lymph nodes?
A: Involvement of the lymph nodes tells us your cancer might spread into the rest of your body and will need more aggressive treatment.
Q: What do cancer patients get out of support groups?
A: Support groups offer a safe environment for speaking up about what youre feeling and an opportunity to benefit from other peoples experiences. But cancer experiences are so different, depending on how old you are and what your stage is, that many doctors recommend finding a specialized group. Most cancer centers can direct you to the appropriate support group.
Q: Im a wreck, but I dont like support groups. What can I do?
A: Another great option for breast cancer patients looking for support is one-on-one counseling with a social worker, psychologist, or psychiatrist. Or try a virtual support group online.
Q: My head is spinning! How can I make sure I understand the important parts of my diagnosis?
A: Most people find this part of the experience very confusing: Right in the middle of a very traumatic experience, you suddenly need to learn a new language and pay close attention to all this new information. Bringing a friend or family member to your appointments may be a good ideanot just to listen but to ask extra questionsand some people like to tape record conversations with their doctors. It may also help to take notes and keep copies of all your reports (mammography, ultrasound, breast MRI, pathology).
Q: Should I go online to learn more about my diagnosis?
A: The Web is a great tool because it allows you to digest information at your own paceaway from the bustle (and stress) of your doctors office. But if youre participating in online message boards, dont forget that you may cross paths with women whose treatment options and experiences dont apply to your situation at all.
Q: How can I make sure to get the best care?
A: Its important to be your own advocate and hunt down information from a range of sources. But sometimes you need to follow your own gut instincts. If youre not comfortable with your physician, for instance, or if you have any doubts about the care youre getting, find a new doctor or seek a second opinion.
Q: Why should I consider getting a second opinion?
A: A second opinion can be very reassuring when you have a pathology report in hand and need a range of interpretations about what it means for your treatment. When two physicians at different institutions tell you the same thing, it serves to reinforce the diagnosis; when they dont, you might want a third opinion. You may also want to consider having your slides reviewed by an additional pathologist.